LF:BVKV0421p Clinical Nutrition I -lec. - Course Information

BVKV0421p Clinical Nutrition and Dietetics I - lecture

Extent and Intensity

2/0/0. 0 credit(s). Type of Completion: -.

Teacher(s)

MUDr. Milan Majerník (lecturer)
MUDr. Michal Šenkyřík (lecturer)
doc. MUDr. Miroslav Tomíška, CSc. (lecturer)
Mgr. Aleš Peřina, Ph.D. (assistant)

Guaranteed by

doc. MUDr. Miroslav Tomíška, CSc.
Department of Internal Medicine, Hematology and Oncology – Joint workplaces with the University Hospital Brno - workplaces of the Bohunice and Mater. Hospital – Faculty of Medicine
Contact Person: MVDr. Halina Matějová
Supplier department: Department of Public Health – Theoretical Departments – Faculty of Medicine

Timetable

Tue 15:30–18:50 IGEK N15190

Prerequisites (in Czech)

BVLV0321p Nutrition therapy && BVLV0321c Nutrition therapy I - exercises

Course Enrolment Limitations

The course is only offered to the students of the study fields the course is directly associated with.

fields of study / plans the course is directly associated with

• Nutritive therapist (programme LF, B-SZ)
• Dietitian (programme LF, B-NUT)

Course objectives

The aim of instruction in the course of Clinical Nutrition and Dietetics is to acquaint students of the Bachelor study programme with various possibilities and ways of nutritional intervention in individuals with nutrition disorders (malnutrition in the wider sense of the word). The curriculum comprises both the problems of undernourishment (protein-energy malnutrition) and problems of hypernutrition, obesity, dyslipidemia, and metabolic syndrome. Also included are the most frequent defects of metabolism. In each of the above-mentioned areas, instruction comprises both a detailed diagnostics of the respective nutrition disorder and the possibilities of its treatment in current clinical practice. At the same time the whole instruction in the course of Clinical Nutrition is oriented towards the practical ways of utilising the knowledge obtained. With regard to undernourishment, stress is laid on the diagnosis of protein-energy malnutrition and on the standard way of evaluation of the degree of severity of this disorder. Basing on this, various forms of nutritional support are taught with emphasis on correct application of artificial nutrition. The study comprises both the various ways of dietary intervention and peroral supplementation with nutrition preparations, and the ways of enteral nutrition delivered into the gastrointestinal tract by means of a probe, as well as parenteral nutrition applied into the vein by infusions. In all cases provision of nutritional support to hospitalised patients in hospital conditions is analysed separately, and so is long-term provision of domestic artificial nutrition in outpatient conditions. A part of the course is formed by monitoring the patient during the administration of artificial nutrition, both with regard to its effect and the possible undesirable effects and complications. With respect to obesity, the curriculum is primarily devoted to the clinically severe disorder with the necessity of intervention by very low calorie diet, or pharmacological or surgical interventions. The set of problems relating to metabolic syndrome and dyslipidemia is taught in its whole extent. Practical instruction at the patient’s bedside is part of the course. The students learn to be capable of examining the nutritional state of a particular patient, to quantify the severity of his/her nutrition disorder and, basing on this, to decide on the respective suitable type of nutritional support. They learn to follow the patient in the course of the support, including patients with artificial nutrition, especially if applied by enteral probe. In these patients the students are capable of monitoring the tolerance to enteral nutrition, its effect, undesirable effects, and complications. The curriculum also includes economic and ethical aspects of nutritional support, understanding of clinical research results, and an outline of possible advances in the near future.

Learning outcomes

Student will be able to identify the nutritional problem after graduation, to apply various ways of dietary intervention, their monitoring and evaluation. He will also be able to understand the results of clinical research.

Syllabus

• 1) Energy metabolism of principal nutrients in healthy individuals during simple fasting and in disease. Basal metabolism. Harris-Benedict equation. Energy balance. Indirect calorimetry, principle of the method, respiratory quotient, interpretation of results. Determination of energy demand of patients in clinical practice. 2) Metabolism of amino acids. The cycle of urea production. Nitrogen balance. Essential and branched-chain amino acids. Glutamine. Arginine. Demand for proteins/amino acids in nutrition in various clinical situations. The relationship between protein and energy demands. 3) Metabolism of fats and saccharides. Saturated, monounsaturated, and polyunsaturated fatty acids. The effect of n-6 and n-3 fatty acids on inflammation and blood coagulation. Fatty acids with mean length of chain. Deficit of essential fatty acids. Chylomicrons; LDL, VLDL, and HDL particles in blood circulation. 4) Mineral substances in nutrition: Na, K, Cl, Ca, P, and Mg. Water balance, ion balance, and acid-basic balance. 5) Vitamins in nutrition. Survey, recommended daily doses in patient nutrition. 6) Trace elements in nutrition. Survey, recommended daily doses in patient nutrition. 7) Dietary fibre in nutrition. Survey of the various types of fibre. Short-chain fatty acids. Probiotics and prebiotics. Synbiotics. 8) Hormones and nutrition. Insulin and insulin-like growth factor (IGF-I). Growth hormone. Anabolic steroids. 9) Malnutrition. Two extreme types of malnutrition: marasmus and protein malnutrition. The concept of protein-energy malnutrition. Deficiency states. 10) Anamnestic methods of detection of malnutrition. Detailed nutrition history. Significance of body mass loss. Questionnaire methods of nutrition intake: 24-hour recall, 3-day prospective record of dietary intake, 7-day record, questionnaire of foodstuff intake frequency. 11) Somatic examination of malnutrition. The principle of anthropometry. Basic anthropometric values determined on the arm, their measurement and interpretation of results. 12) Laboratory methods of determination of nutritional state. Basic metabolic laboratory examinations. Nutritional proteins. Ion and nitrogen waste in urine. 13) Simple models of body composition. Two-compartment model of body composition: body fat mass and non-fat mass. Special methods of examination of body composition: underwater weighing, bioelectrical impedance analysis, examination by means of infrared radiation, body composition densitometry, determination of whole-body content of nitrogen and potassium, double-labelled water examination. 14) Global evaluation of nutritional state. Searching for patients at risk of malnutrition (nutrition screening). Occurrence and significance of protein-energy malnutrition in hospital. 15) Artificial nutrition. General aspects of enteral and parenteral nutrition. Advantages and disadvantages of enteral and parenteral nutrition. Indications and contraindications. 16) Enteral nutrition by means of probes, access ways to gastrointestinal tract. Procedure for introduction of nasogastric and nasojejunal probes. Checking correct position of probe. Performance of percutaneous endoscopic gastrostomy. Introduction of nutritional catheter jejunostomy. 17) Survey of pharmaceutical preparations of liquid enteral nutrition. Polymeric and oligomeric preparations. Sipping preparations. Special preparations according to type of disease. Modulated enteral nutrition. immunomodulatory nutrition. 18) Methods of application of enteral probe nutrition. Continuous, intermittent, and bolus nutrition. Gastric and postpyloric nutrition. Principles of administration of enteral probe nutrition; demands for aseptic approach. Rehabilitation of patients with nutritional support. 19) Monitoring of the patient’s condition during enteral probe nutrition. Checking of tolerance to the nutrition administered and assessment of its efficiency. Laboratory monitoring of patients during enteral probe nutrition. 20) Complications of enteral probe nutrition. Intolerance to nutrition. Mechanical complications, especially blockage and unintentional unplugging of probe. Metabolic and infectious complications.

Literature

required literature
• TOMÍŠKA, Miroslav. Výživa onkologických pacientů. První vydání. Praha: Mladá fronta, 2018, 743 stran. ISBN 9788020440648. info

recommended literature
• Krause's food & the nutrition care process. Edited by L. Kathleen Mahan - Janice L. Raymond. 14th edition. St. Louis, Missouri: Elsevier, 2017, xvii, 1134. ISBN 9780323340755. info

not specified
• SVAČINA, Štěpán. Klinická dietologie. 1. vyd. Praha: Grada, 2008, 381 s. ISBN 9788024722566. info
• Krause's food & nutrition therapy. Edited by L. Kathleen Mahan - Sylvia Escott-Stump. 12th ed. St. Louis, Mo.: Saunders, 2008, xxiv, 1352. ISBN 9781416034018. info
• GROFOVÁ, Zuzana. Nutriční podpora : praktický rádce pro sestry. Vyd. 1. Praha: Grada, 2007, 237 s. ISBN 9788024718682. info
• Nutritional oncology. Edited by David Heber. 2nd ed. Amsterdam: Elsevier-Academic Press, 2006, xxiv, 822. ISBN 0120883937. info
• Basics in clinical nutrition. Edited by Luboš Sobotka - S. P. Allison. 3rd ed. Prague: Galén, 2004, 500 s. ISBN 8072622927. info
• HAINER, Vojtěch. Základy klinické obezitologie. Vyd. 1. Praha: Grada, 2004, 356 s. ISBN 8024702339. info
• CATALDO, Corrine Balog, Linda K. DEBRUYNE and Eleanor Noss WHITNEY. Nutrition and diet therapy : principles and practice. 6th ed. Belmont: Thomson, 2003, xvii, 732. ISBN 0534576915. URL info
• NEVORAL, Jiří. Výživa v dětském věku. Vydání první. Jinočany: H & H, 2003, 434 stran. ISBN 8086022935. info
• ZADÁK, Zdeněk. Výživa v intenzivní péči. 1. vyd. Praha: Grada, 2002, 487 s. ISBN 8024703203. info
• WILHELM, Zdeněk, Petr BENEŠ, Vladimír BLÁHA, Jiří BONAVENTURA, Miloslav HRONEK, Pavel KOHOUT, Jaromír KOŽOUŠEK, Luboš SOBOTKA, Pavel TĚŠÍNSKÝ, Miroslav TOMIŠKA, Mária VOLEKOVÁ and Zdeněk ZADÁK. Výživa v onkologii. 1st ed. Brno: Institut pro další vzdělávání pracovníků ve zdravotnictví v Brně, 2001, 190 pp. ISBN 80-7013-326-0. info
• NAVRÁTILOVÁ, Miroslava, Eva ČEŠKOVÁ and Ladislav SOBOTKA. Klinická výživa v psychiatrii. Praha: Maxdorf-Jesenius, 2000, 270 pp. ISBN 80-85912-33-3. info
• KELLER, U., R. MEIER and S. BERTOLI. Klinická výživa. Translated by Z. Slabochová. 1. vyd. Praha: Scientia Medica, 1993, 236 s. ISBN 80-85526-08-5. info

Teaching methods

lectures

Assessment methods

credit

Language of instruction

Czech

Further comments (probably available only in Czech)

Study Materials
The course is taught annually.
Information on the extent and intensity of the course: 30.

• Enrolment Statistics (spring 2020, recent)
  
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